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betamethasone acetate and sodium phosphate
Pharmacologic class: Glucocorticoid (inhalation)
Therapeutic class: Antiasthmatic, antiinflammatory (steroidal)
Pregnancy risk category C
Stabilizes lysosomal neutrophils and prevents their degranulation, inhibits synthesis of lipoxygenase products and prostaglandins, activates anti-inflammatory genes, and inhibits various cytokines
Solution for injection: 3 mg betamethasone sodium phosphate with 3 mg betamethasone acetate/ml
Suspension for injection (acetate, phosphate): 6 mg (total)/ml
Syrup: 0.6 mg/5 ml
Tablets: 0.6 mg
Tablets (effervescent): 0.5 mg
Tablets (extended-release): 1 mg
Indications and dosages
➣ Inflammatory, allergic, hematologic, neoplastic, autoimmune, and respiratory diseases; prevention of organ rejection after transplantation surgery
Adults: 0.6 to 7.2 mg/day P.O. as single daily dose or in divided doses; or up to 9 mg I.M. of betamethasone acetate and sodium phosphate suspension.
➣ Bursitis or tenosynovitis
Adults: 1 ml of suspension intrabursally
➣ Rheumatoid arthritis or osteoarthritis
Adults: 0.5 to 2 ml of suspension intra-articularly
• Respiratory distress syndrome
• Hypersensitivity to drug
Use cautiously in:
• systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability
• patients receiving systemic corticosteroids
• pregnant patients
• children younger than age 6.
• Give as a single daily dose before 9:00 A.M.
• Give oral dose with food or milk.
• Administer I.M. injection deep into gluteal muscle (may cause tissue atrophy).
☞ Don't give betamethasone acetate I.V.
• Be aware that typical suspension dosage ranges from one-third to one-half of oral dosage given q 12 hours.
☞ To avoid adrenal insufficiency, taper dosage slowly and under close supervision when discontinuing.
• Know that drug may be given with other immunosuppressants.
CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure
CV: hypertension, thrombophlebitis, thromboembolism
EENT: cataracts, burning and dryness of eyes, rebound nasal congestion, sneezing, epistaxis, nasal septum perforation, difficulty speaking, oropharyngeal or nasopharyngeal fungal infections
GI: nausea, vomiting, anorexia, dry mouth, esophageal candidiasis, peptic ulcers
Metabolic: decreased growth, hyperglycemia, cushingoid appearance, adrenal insufficiency or suppression
Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis
Respiratory: cough, wheezing, bronchospasm
Skin: facial edema, rash, contact dermatitis, acne, ecchymosis, hirsutism, petechiae, urticaria, angioedema
Other: loss of taste, bad taste, weight gain or loss, Churg-Strauss syndrome, increased susceptibility to infection, hypersensitivity reaction
Drug-drug. Amphotericin B, loop and thiazide diuretics, ticarcillin: additive hypokalemia
Barbiturates, phenytoin, rifampin: stimulation of betamethasone metabolism, causing decreased drug effects
Digoxin: increased risk of digoxin toxicity
Fluoroquinolones (such as ciprofloxacin, norfloxacin): increased risk of tendon rupture
Hormonal contraceptives: blockage of betamethasone metabolism
Insulin, oral hypoglycemics: increased betamethasone dosage requirement, diminished hypoglycemic effects
Live-virus vaccines: decreased antibody response to vaccine, increased risk of neurologic complications
Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI effects
Drug-diagnostic tests. Calcium, potassium: decreased levels
Cholesterol, glucose: increased levels
Nitroblue tetrazolium test for bacterial
infection: false-negative result
Drug-herbs. Echinacea: increased immune-stimulating effects
Ginseng: increased immune-modulating effects
Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers
• Monitor weight daily and report sudden increase, which suggests fluid retention.
• Monitor blood glucose level for hyperglycemia.
• Assess serum electrolyte levels for sodium and potassium imbalances.
• Watch for signs and symptoms of infection (which drug may mask).
• Advise patient to report signs and symptoms of infection.
• Tell patient to report visual disturbances (long-term drug use may cause cataracts).
• Instruct patient to eat low-sodium, high potassium diet.
☞ Advise patient to carry medical identification describing drug therapy.
• Inform female patients that drug may cause menstrual irregularities.
☞ Caution patient not to stop taking drug abruptly.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
betamethasone (systemic)(bay-ta-meth-a-sone) ,
ClassificationTherapeutic: anti inflammatories steroidal
- Autoimmune disorders.
Time/action profile (anti-inflammatory activity)
|IM (sodium phosphate/acetate)||1–3 hr||unknown||1 wk|
Adverse Reactions/Side EffectsAdverse reactions/side effects are much more common with high-dose/long-term therapy
Central nervous system
- depression (most frequent)
- euphoria (most frequent)
- ↑ intracranial pressure (children only)
- personality changes
Ear, Eye, Nose, Throat
- ↑ intraocular pressure
- hypertension (most frequent)
- peptic ulceration (life-threatening)
- anorexia (most frequent)
- nausea (most frequent)
- acne (most frequent)
- ↓ wound healing (most frequent)
- ecchymoses (most frequent)
- fragility (most frequent)
- hirsutism (most frequent)
- petechiae (most frequent)
- adrenal suppression (most frequent)
Fluid and Electrolyte
- fluid retention (long-term high doses)
- hypokalemic alkalosis
- thromboembolism (life-threatening)
- weight gain
- weight loss
- muscle wasting (most frequent)
- osteoporosis (most frequent)
- avascular necrosis of joints
- muscle pain
- cushingoid appearance (moon face, buffalo hump) (most frequent)
- ↑ susceptibility to infection
Drug-Drug interactionAdditive hypokalemia withthiazide and loopdiuretics, or amphotericin B.Hypokalemia may ↑ risk of digitalis glycoside toxicity.May ↑ requirement for insulins or oral hypoglycemic agents.Phenytoin,phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness. Oral contraceptives may block metabolism.↑ risk of adverse GI effects with NSAIDs (including aspirin).At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
Availability (generic available)
- Indicated for many conditions. Assess involved systems before and periodically during therapy.
- Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy.
- Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur.
- Pediatric: Children should have periodic growth evaluations.
- Lab Test Considerations: Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum glucose evaluated. May ↓ WBC counts. May ↓ serum potassium and calcium and ↑ serum sodium concentrations.
- Guaiac-test stools. Promptly report presence of guaiac-positive stools.
- May ↑ serum cholesterol and lipid values. May decrease uptake of thyroid 123I or 131I.
- Suppress reactions to allergy skin tests.
- Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.
Potential Nursing DiagnosesRisk for infection (Side Effects)
Disturbed body image (Side Effects)
- If dose is ordered daily or every other day, administer in the morning to coincide with the body’s normal secretion of cortisol.
- Intramuscular: Shake suspension well before drawing up. Do not dilute with other solution or admix. Do not administer suspensions IV.
- Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.
- Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
- Caution patient to avoid vaccinations without first consulting health care professional.
- Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occurPatient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
- Advise patient to notify health care professional of medication regimen before treatment or surgery.
- Discuss possible effects on body image. Explore coping mechanisms.
- Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
- Advise patient to carry identification describing disease process and medication regimen in the event of an emergency in which patient cannot relate medical history.
- Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
- Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see ). Alcohol should be avoided during therapy.
- Decrease in presenting symptoms with minimal systemic side effects.
- Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
- Management of symptoms in adrenal insufficiency.